Alignment CT

ABSTRACT

Methods and systems for navigating to a target through a patient&#39;s bronchial tree are disclosed including a bronchoscope, a probe insertable into a working channel of the bronchoscope including a location sensor, and a workstation in operative communication with the probe and the bronchoscope the workstation including a user interface that guides a user through a navigation plan and is configured to present a three-dimensional (3D) view for displaying a 3D rendering of the patient&#39;s airways and a corresponding navigation plan, a local view for assisting the user in navigating the probe through peripheral airways of the patient&#39;s bronchial tree to the target, and a target alignment view for assisting the user in aligning a distal tip of the probe with the target.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/790,395, filed Jul. 2, 2015, entitled ALIGNMENT CT, which claims thebenefit of the filing date of provisional U.S. Patent Application. No.62/020,245, filed Jul. 2, 2014, the entire contents of each of which areincorporated herein by reference.

BACKGROUND 1. Technical Field

The present disclosure relates to systems and methods for internallyguided navigation of catheters based on a three-dimensional modelgenerated from CT image data.

2. Discussion of Related Art

Visualization techniques related to visualizing a patient's lungs havebeen developed so as to help clinicians perform diagnoses and/orsurgeries on the patient's lungs. Visualization is especially importantfor identifying a location of a diseased region. Further, when treatingthe diseased region, additional emphasis is given to identification ofthe particular location of the diseased region so that a surgicaloperation is performed at the correct location.

In the past, scanned two-dimensional (2D) images of the lungs have beenused to aid in visualization. In order to obtain the scanned 2D images,a patient undergoes multiple CT scans. In addition to using scanned 2Dimages, three-dimensional (3D) models may also be used to virtuallynavigate through the body. The use of 3D models for navigation is morecomplex than using 2D images. One of the challenges involves guiding auser to point the catheter to the target in 3D. Many views have beendeveloped, some of them using multiple cross-sections, and a proposedview is designed to assist with guidance. However, when one tries tolook through the whole volume from a point of view instead of looking ata cross-section, the view may be obstructed and objects, which arebehind other objects, might not be seen. Methods have been developed toalleviate the obstructed view problem, such as adding transparency tosome of the volume or highlighting farther objects. One of the knownmethods involves Maximum Intensity Projection (MIP) which is a volumerendering method for 3D data that projects in the visualization planethe voxels with maximum intensity that fall in the way of parallel raystraced from the viewpoint to the plane of projection. Thus, two MIPrenderings from opposite viewpoints are symmetrical images if they arerendered using orthographic projection. However, when using MIP to alignan electromagnetic navigation catheter towards a specific point(lesion), objects which are “behind” the lesion, such as ribs or othernon-soft tissue, might be shown instead of the lesion.

SUMMARY

In an embodiment, the present disclosure discloses a system fornavigating to a target through a patient's bronchial tree. The systemincludes a bronchoscope configured for insertion into the patient'sbronchial tree where the bronchoscope defines a working channel, a probeinsertable into the working channel of the bronchoscope and configuredto navigate through the patient's bronchial tree, the probe including alocation sensor, and a workstation in operative communication with theprobe and the bronchoscope. The workstation includes a memory and atleast one processor, the memory storing a navigation plan and a programthat, when executed by the processor, presents a user interface thatguides a user through the navigation plan. The user interface presents athree-dimensional (3D) view for displaying a 3D rendering of thepatient's airways and a corresponding navigation plan, a local view forassisting the user in navigating the probe through peripheral airways ofthe patient's bronchial tree to the target, and a target alignment viewfor assisting the user in aligning a distal tip of the probe with thetarget.

In an aspect, the processor executes a maximum intensity projection(MIP) algorithm for a range from a distal tip of the location sensor.

In another aspect, the range is predetermined.

In yet another aspect, the range is dynamically calculated based on alocation of the target.

In an aspect, the MIP algorithm causes the target to be displayed in amaximal surface size in the target alignment view.

In another aspect, the MIP algorithm highlights the target and filtersout densities of other tissue near the target.

In an aspect, the target alignment view presents a marking overlaid onthe target.

In another aspect, the target alignment view presents a crosshair toassist alignment to a center of the target.

In yet another aspect, the target alignment view presents a distancefrom a tip of the location sensor to the target.

In another embodiment, the present disclosure discloses a system fornavigating to a target through a patient's bronchial tree. The systemincludes a bronchoscope configured for insertion into the patient'sbronchial tree where the bronchoscope defines a working channel, a probeinsertable into the working channel of the bronchoscope and configuredto navigate through the patient's bronchial tree, the probe including alocation sensor, and a workstation in operative communication with theprobe and the bronchoscope. The workstation includes a memory and atleast one processor, the memory storing a navigation plan and a programthat, when executed by the processor, presents a user interface thatguides a user through the navigation plan, the user interface configuredto present a target alignment view for assisting the user in aligning adistal tip of the probe with the target. The processor executes amaximum intensity projection (MIP) algorithm for a limited range from adistal tip of the location sensor.

In an aspect, the limited range is predetermined.

In another aspect, the limited range is dynamically calculated based ona location of the target.

In an aspect, the MIP algorithm causes the target to be displayed in amaximal surface size in the target alignment view.

In another aspect, the MIP algorithm highlights the target and filtersout densities of other tissue near the target.

In an aspect, the target alignment view presents a marking overlaid onthe target.

In another aspect, the target alignment view presents a crosshair toassist alignment to a center of the target.

In yet another aspect, the target alignment view presents a distancefrom a tip of the location sensor to the target.

Any of the above aspects and embodiments of the present disclosure maybe combined without departing from the scope of the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects and features of the present disclosure are describedhereinbelow with references to the drawings, wherein:

FIG. 1 is a perspective view of an electromagnetic navigation system inaccordance with the present disclosure;

FIG. 2 is a schematic diagram of a workstation configured for use withthe system of FIG. 1;

FIG. 3 is a flow chart illustrating a method of navigation in accordancewith an embodiment of the present disclosure; and

FIG. 4 is an illustration of a user interface of the workstation of FIG.2 presenting a view for performing registration in accordance with thepresent disclosure.

DETAILED DESCRIPTION

The present disclosure is related to devices, systems, and methods forinternally guided navigation of catheters based on a three-dimensionalmodel generated from CT image data to align the catheter toward a targetarea. In the present disclosure, the system provides a view with adefined section of volume based on a range from the catheter or asection of the volume in vicinity of a target area or lesion. Alignmentof the catheter may be a necessary component of pathway planning forperforming an ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY® (ENB) procedureusing an electromagnetic navigation (EMN) system.

An ENB procedure generally involves at least two phases: (1) planning apathway to a target located within, or adjacent to, the patient's lungs;and (2) navigating a probe to the target along the planned pathway.These phases are generally referred to as (1) “planning” and (2)“navigation.” The planning phase of an ENB procedure is more fullydescribed in commonly-owned U.S. patent application Ser. Nos.13/838,805; 13/838,997; and Ser. No. 13/839,224, all entitled “PathwayPlanning System and Method,” filed on Mar. 15, 2013, by Baker, theentire contents of which are hereby incorporated by reference. Anexample of the planning software can be found in commonly assigned U.S.Provision Patent Application No. 62/020,240 entitled “SYSTEM AND METHODFOR NAVIGATING WITHIN THE LUNG” the entire contents of which areincorporated herein by reference.

Prior to the planning phase, the patient's lungs are imaged by, forexample, a computed tomography (CT) scan, although additional applicablemethods of imaging will be known to those skilled in the art. The imagedata assembled during the CT scan may then be stored in, for example,the Digital Imaging and Communications in Medicine (DICOM) format,although additional applicable formats will be known to those skilled inthe art. The CT scan image data may then be loaded into a planningsoftware application (“application”) to be used during the planningphase of the ENB procedure.

Embodiments of the systems and methods are described with reference tothe accompanying drawings Like reference numerals may refer to similaror identical elements throughout the description of the figures. Thisdescription may use the phrases “in an embodiment,” “in embodiments,”“in some embodiments,” or “in other embodiments,” which may each referto one or more of the same or different embodiments in accordance withthe present disclosure.

With reference to FIG. 1, an electromagnetic navigation (EMN) system 10is provided in accordance with the present disclosure. Among other tasksthat may be performed using the EMN system 10 are planning a pathway totarget tissue, navigating a positioning assembly to the target tissue,navigating a biopsy tool to the target tissue to obtain a tissue samplefrom the target tissue using the biopsy tool, and digitally marking thelocation where the tissue sample was obtained, and placing one or moreechogenic markers at or around the target.

EMN system 10 generally includes an operating table 40 configured tosupport a patient; a bronchoscope 50 configured for insertion throughthe patient's mouth and/or nose into the patient's airways; monitoringequipment 60 coupled to bronchoscope 50 for displaying video imagesreceived from bronchoscope 50; a tracking system 70 including a trackingmodule 72, a plurality of reference sensors 74, and an electromagneticfield generator 76; a workstation 80 including software and/or hardwareused to facilitate pathway planning, identification of target tissue,navigation to target tissue, and digitally marking the biopsy location

FIG. 1 also depicts two types of catheter guide assemblies 90, 100. Bothcatheter guide assemblies 90, 100 are usable with the EMN system 10 andshare a number of common components. Each catheter guide assembly 90,100 includes a handle 91, which is connected to an extended workingchannel (EWC) 96. The EWC 96 is sized for placement into the workingchannel of a bronchoscope 50. In operation, a locatable guide (LG) 92,including an electromagnetic (EM) sensor 94, is inserted into the EWC 96and locked into position such that the sensor 94 extends a desireddistance beyond the distal tip 93 of the EWC 96. The location of the EMsensor 94, and thus the distal end of the EWC 96, within anelectromagnetic field generated by the electromagnetic field generator76 can be derived by the tracking module 72, and the workstation 80.

Turning now to FIG. 2, there is shown a system diagram of workstation80. Workstation 80 may include memory 202, processor 204, display 206,network interface 208, input device 210, and/or output module 212.Workstation 80 implements the methods that will be described herein.

FIG. 3 depicts a method of navigation using the navigation workstation80 and the user interface 216. In step S300 user interface 216 presentsthe clinician with a view (not shown) for the selection of a patient.The clinician may enter patient information such as, for example, thepatient name or patient ID number, into a text box to select a patienton which to perform a navigation procedure. Alternatively, the patientmay be selected from a drop down menu or other similar methods ofpatient selection. Once the patient has been selected, the userinterface 216 presents the clinician with a view (not shown) including alist of available navigation plans for the selected patient. In stepS302, the clinician may load one of the navigation plans by activatingthe navigation plan. The navigation plans may be imported from aprocedure planning software and include CT images of the selectedpatient.

Once the patient has been selected and a corresponding navigation planhas been loaded, the user interface 216 presents the clinician with apatient details view (not shown) in step S304 which allows the clinicianto review the selected patient and plan details. Examples of patientdetails presented to the clinician in the timeout view may include thepatient's name, patient ID number, and birth date. Examples of plandetails include navigation plan details, automatic registration status,and/or manual registration status. For example, the clinician mayactivate the navigation plan details to review the navigation plan, andmay verify the availability of automatic registration and/or manualregistration. The clinician may also activate an edit button (not shown)to edit the loaded navigation plan from the patient details view.Activating the edit button (not shown) of the loaded navigation plan mayalso activate the planning software described above. Once the clinicianis satisfied that the patient and plan details are correct, theclinician proceeds to navigation setup in step S306. Alternatively,medical staff may perform the navigation setup prior to or concurrentlywith the clinician selecting the patient and navigation plan.

During navigation setup in step S306, the clinician or other medicalstaff prepares the patient and operating table by positioning thepatient on the operating table over the electromagnetic field generator76. The clinician or other medical staff position reference sensors 74on the patient's chest and verify that the sensors are properlypositioned, for example, through the use of a setup view (not shown)presented to the clinician or other medical staff by user interface 216.Setup view may, for example, provide the clinician or other medicalstaff with an indication of where the reference sensors 74 are locatedrelative to the magnetic field generated by the transmitter mat 76.Patient sensors allow the navigation system to compensate for patientbreathing cycles during navigation. The clinician also prepares LG 92,EWC 96, and bronchoscope 50 for the procedure by inserting LG 92 intoEWC 96 and inserting both LG 92 and EWC 96 into the working channel ofbronchoscope 50 such that distal tip 93 of LG 92 extends from the distalend of the working channel of bronchoscope 50. For example, theclinician may extend the distal tip 93 of LG 92 10 mm beyond the distalend of the working channel of bronchoscope 50.

Once setup is complete, the workstation 80 presents a view 400, as shownin FIG. 4, via the user interface 216. CT image data is acquired anddisplayed in alignment view 402 of view 400 in step 308. In step 310,the CT image data is registered with the selected navigation plan. Anexample method for registering images with a navigation plan isdescribed in U.S. Provisional Patent Application Ser. No. 62/020,240entitled “System and Method for Navigating Within the Lung,” filed onJul. 2, 2014, by Brown et al., the entire contents of each of which areincorporated herein by reference and useable with the EMN system 10 asdescribed herein.

In step s312, workstation 80 performs a volume rendering algorithm basedon the CT image data included in the navigation plan and positionsignals from sensor 94 to generate a 3D view 404 of the walls of thepatient's airways as shown in FIG. 4. The 3D view 404 uses a perspectiverendering that supports perception of advancement when moving closer toobjects in the volume. The 3D view 404 also presents the user with anavigation pathway providing an indication of the direction along whichthe user will need to travel to reach the lesion 410. The navigationpathway may be presented in a color or shape that contrasts with the 3Drendering so that the user may easily determine the desired path totravel. Workstation 80 also presents a local view 406 as shown in FIG. 4that includes a slice of the 3D volume located at and aligned with thedistal tip 93 of LG 92. Local view 406 shows the lesion 410 and thenavigation pathway 414 overlaid on slice 416 from an elevatedperspective. The slice 416 that is presented by local view 406 changesbased on the location of EM sensor 94 relative to the 3D volume of theloaded navigation plan. Local view 406 also presents the user with avirtual representation of the distal tip 93 of LG 92 in the form of avirtual probe 418. The virtual probe 418 provides the user with anindication of the direction that distal tip 93 of LG 92 is facing sothat the user can control the advancement of the LG 92 in the patient'sairways.

In step s314, the catheter is navigated through the bronchi. While thecatheter is navigated through the bronchi, workstation 80 executes anMIP algorithm to calculate the MIP in a limited range from the distaltip 93 in step s316 and displays the MIP in step s318. The limited rangemay be predefined or be dynamically calculated based on a location ofthe target. For example, the limited range may be 35 mm from the distaltip 93. Limiting the MIP algorithm to highlight structures within thelimited range of the distal tip 93 may reduce the load on processor 204.By using a limited range, denser structures that may obscure the lesionmay be omitted permitting the lesion to be displayed. The MIP algorithmcauses lesions within the limited range to be displayed in their maximalsurface size permitting the user to aim for the center of the target. Asshown in alignment view 402, the MIP algorithm may be tuned to highlightlesion-density tissue and filter out most other densities in the CTvolume, creating a clearer picture in which lung lesions stand out overdark background. A marking 408, e.g., a green sphere or ellipsoid, maybe used to represent the planned target and is overlaid on the renderedvolume to reduce risk of aligning to the wrong object. A crosshair 410in the center of the view assists the user in aligning distal tip 93with the center of the target. The distance 412 from the distal tip 93to the center of the marked target is displayed next to the crosshair410, permitting the user to find the best balance between alignment andproximity.

In step s320, a determination is made as to whether the lesion is withinthe limited range. The determination may be made by a user or it may bedetermined using known image analysis techniques. If the lesion is notwithin the limited range of the distal tip 93, the process returns tostep s314 where the user continues to navigate the catheter.

In the embodiments described herein, the alignment of the catheter usingCT image data and 3D models permits a better aiming experience overother CT volume representations. Target areas of lesions may be shownfrom a distance, where a normal CT slice would not be useful. The targetis shown at a limited range as opposed to normal MIP that may show moredense and distal objects that obscure the lesion. The embodiments permita user to assess optimal balance between alignment/proximity, whichdefines the best location for biopsy tool introduction. The view lookssimilar to CT images thereby psychologically assuring physicians thatthe information they are looking at is real, permits aiming to variousparts of the lesion structure, and assures users that they are at theplanned target. In the 3D models, irrelevant structures in the range areminimized permitting the user to clearly identify the lesion.

Referring back to FIG. 1, catheter guide assemblies 90, 100 havedifferent operating mechanisms, but each contain a handle 91 that can bemanipulated by rotation and compression to steer the distal tip 93 ofthe LG 92, extended working channel 96. Catheter guide assemblies 90 arecurrently marketed and sold by Covidien LP under the nameSUPERDIMENSION® Procedure Kits, similarly catheter guide assemblies 100are currently sold by Covidien LP under the name EDGE™ Procedure Kits,both kits include a handle 91, extended working channel 96, andlocatable guide 92. For a more detailed description of the catheterguide assemblies 90, 100 reference is made to commonly-owned U.S. patentapplication Ser. No. 13/836,203 filed on Mar. 15, 2013 by Ladtkow etal., the entire contents of which are hereby incorporated by reference.

As illustrated in FIG. 1, the patient is shown lying on operating table40 with bronchoscope 50 inserted through the patient's mouth and intothe patient's airways. Bronchoscope 50 includes a source of illuminationand a video imaging system (not explicitly shown) and is coupled tomonitoring equipment 60, e.g., a video display, for displaying the videoimages received from the video imaging system of bronchoscope 50.

Catheter guide assemblies 90, 100 including LG 92 and EWC 96 areconfigured for insertion through a working channel of bronchoscope 50into the patient's airways (although the catheter guide assemblies 90,100 may alternatively be used without bronchoscope 50). The LG 92 andEWC 96 are selectively lockable relative to one another via a lockingmechanism 99. A six degrees-of-freedom electromagnetic tracking system70, e.g., similar to those disclosed in U.S. Pat. No. 6,188,355 andpublished PCT Application Nos. WO 00/10456 and WO 01/67035, the entirecontents of each of which is incorporated herein by reference, or anyother suitable positioning measuring system, is utilized for performingnavigation, although other configurations are also contemplated.Tracking system 70 is configured for use with catheter guide assemblies90, 100 to track the position of the EM sensor 94 as it moves inconjunction with the EWC 96 through the airways of the patient, asdetailed below.

As shown in FIG. 1, electromagnetic field generator 76 is positionedbeneath the patient. Electromagnetic field generator 76 and theplurality of reference sensors 74 are interconnected with trackingmodule 72, which derives the location of each reference sensor 74 in sixdegrees of freedom. One or more of reference sensors 74 are attached tothe chest of the patient. The six degrees of freedom coordinates ofreference sensors 74 are sent to workstation 80, which includesapplication 81 where sensors 74 are used to calculate a patientcoordinate frame of reference.

Also shown in FIG. 1 is a catheter biopsy tool 102 that is insertableinto the catheter guide assemblies 90, 100 following navigation to atarget and removal of the LG 92. The biopsy tool 102 is used to collectone or more tissue sample from the target tissue. As detailed below,biopsy tool 102 is further configured for use in conjunction withtracking system 70 to facilitate navigation of biopsy tool 102 to thetarget tissue, tracking of a location of biopsy tool 102 as it ismanipulated relative to the target tissue to obtain the tissue sample,and/or marking the location where the tissue sample was obtained.

Although navigation is detailed above with respect to EM sensor 94 beingincluded in the LG 92 it is also envisioned that EM sensor 94 may beembedded or incorporated within biopsy tool 102 where biopsy tool 102may alternatively be utilized for navigation without need of the LG orthe necessary tool exchanges that use of the LG requires. A variety ofuseable biopsy tools are described in U.S. Provisional PatentApplication Nos. 61/906,732 and 61/906,762 both entitled DEVICES,SYSTEMS, AND METHODS FOR NAVIGATING A BIOPSY TOOL TO A TARGET LOCATIONAND OBTAINING A TISSUE SAMPLE USING THE SAME, filed Nov. 20, 2013 andU.S. Provisional Patent Application No. 61/955,407 having the same titleand filed Mar. 14, 2014, the entire contents of each of which areincorporated herein by reference and useable with the EMN system 10 asdescribed herein.

During procedure planning, workstation 80 utilizes computed tomographic(CT) image data for generating and viewing a three-dimensional model(“3D model”) of the patient's airways, enables the identification oftarget tissue on the 3D model (automatically, semi-automatically ormanually), and allows for the selection of a pathway through thepatient's airways to the target tissue. More specifically, the CT scansare processed and assembled into a 3D volume, which is then utilized togenerate the 3D model of the patient's airways. The 3D model may bepresented on a display monitor 81 associated with workstation 80, or inany other suitable fashion. Using workstation 80, various slices of the3D volume and views of the 3D model may be presented and/or may bemanipulated by a clinician to facilitate identification of a target andselection of a suitable pathway through the patient's airways to accessthe target. The 3D model may also show marks of the locations whereprevious biopsies were performed, including the dates, times, and otheridentifying information regarding the tissue samples obtained. Thesemarks may also be selected as the target to which a pathway can beplanned. Once selected, the pathway is saved for use during thenavigation procedure. An example of a suitable pathway planning systemand method is described in U.S. patent application Ser. Nos. 13/838,805;13/838,997; and Ser. No. 13/839,224, filed on Mar. 15, 2014, the entirecontents of each of which are incorporated herein by reference.

During navigation, EM sensor 94, in conjunction with tracking system 70,enables tracking of EM sensor 94 and/or biopsy tool 102 as EM sensor 94or biopsy tool 102 is advanced through the patient's airways.

Referring back to FIG. 2, memory 202 includes any non-transitorycomputer-readable storage media for storing data and/or software that isexecutable by processor 204 and which controls the operation ofworkstation 80. In an embodiment, memory 202 may include one or moresolid-state storage devices such as flash memory chips. Alternatively orin addition to the one or more solid-state storage devices, memory 202may include one or more mass storage devices connected to the processor204 through a mass storage controller (not shown) and a communicationsbus (not shown). Although the description of computer-readable mediacontained herein refers to a solid-state storage, it should beappreciated by those skilled in the art that computer-readable storagemedia can be any available media that can be accessed by the processor204. That is, computer readable storage media includes non-transitory,volatile and non-volatile, removable and non-removable media implementedin any method or technology for storage of information such ascomputer-readable instructions, data structures, program modules orother data. For example, computer-readable storage media includes RAM,ROM, EPROM, EEPROM, flash memory or other solid state memory technology,CD-ROM, DVD, Blu-Ray or other optical storage, magnetic cassettes,magnetic tape, magnetic disk storage or other magnetic storage devices,or any other medium which can be used to store the desired informationand which can be accessed by workstation 80.

Memory 202 may store application 81 and/or CT data 214. Application 81may, when executed by processor 204, cause display 206 to present userinterface 216. Network interface 208 may be configured to connect to anetwork such as a local area network (LAN) consisting of a wired networkand/or a wireless network, a wide area network (WAN), a wireless mobilenetwork, a Bluetooth network, and/or the internet. Input device 210 maybe any device by means of which a user may interact with workstation 80,such as, for example, a mouse, keyboard, foot pedal, touch screen,and/or voice interface. Output module 212 may include any connectivityport or bus, such as, for example, parallel ports, serial ports,universal serial busses (USB), or any other similar connectivity portknown to those skilled in the art.

Any of the herein described methods, programs, algorithms or codes maybe converted to, or expressed in, a programming language or computerprogram. A “Programming Language” and “Computer Program” is any languageused to specify instructions to a computer, and includes (but is notlimited to) these languages and their derivatives: Assembler, Basic,Batch files, BCPL, C, C+, C++, Delphi, Fortran, Java, JavaScript,Machine code, operating system command languages, Pascal, Perl, PL1,scripting languages, Visual Basic, metalanguages which themselvesspecify programs, and all first, second, third, fourth, and fifthgeneration computer languages. Also included are database and other dataschemas, and any other metalanguages. For the purposes of thisdefinition, no distinction is made between languages which areinterpreted, compiled, or use both compiled and interpreted approaches.For the purposes of this definition, no distinction is made betweencompiled and source versions of a program. Thus, reference to a program,where the programming language could exist in more than one state (suchas source, compiled, object, or linked) is a reference to any and allsuch states. The definition also encompasses the actual instructions andthe intent of those instructions.

Further aspects of image and data generation, management, andmanipulation useable in either the planning or navigation phases of anENB procedure are more fully described in commonly-owned U.S.Provisional Patent Application Ser. No. 62/020,220 entitled “Real-TimeAutomatic Registration Feedback,” filed on Jul. 2, 2014, by Brown etal.; U.S. Provisional Patent Application Ser. No. 62/020,177 entitled“Methods for Marking Biopsy Location,” filed on Jul. 2, 2014, by Brown;U.S. Provisional Patent Application Ser. No. 62/020,238 entitled“Intelligent Display,” filed on Jul. 2, 2014, by Kehat et al.; U.S.Provisional Patent Application Ser. No. 62/020,242 entitled “UnifiedCoordinate System For Multiple Ct Scans Of Patient Lungs,” filed on Jul.2, 2014, by Greenburg; U.S. Provisional Patent Application Ser. No.62/020,250 entitled “Algorithm for Fluoroscopic Pose Estimation,” filedon Jul. 2, 2014, by Merlet; U.S. Provisional Patent Application Ser. No.62/020,261 entitled “System and Method for Segmentation of Lung,” filedon Jul. 2, 2014, by Markov et al.; U.S. Provisional Patent ApplicationSer. No. 62/020,253 entitled “Trachea Marking,” filed on Jul. 2, 2014,by Lachmanovich et al.; U.S. Provisional Patent Application Ser. No.62/020,257 entitled “Automatic Detection Of Human Lung Trachea,” filedon Jul. 2, 2014, by Markov et al.; U.S. Provisional Patent ApplicationSer. No. 62/020,261 entitled “Lung And Pleura Segmentation,” filed onJul. 2, 2014, by Markov et al.; U.S. Provisional Patent Application Ser.No. 62/020,258 entitled “Cone View—A Method Of Providing Distance AndOrientation Feedback While Navigating In 3d,” filed on Jul. 2, 2014, byLachmanovich et al.; and U.S. Provisional Patent Application Ser. No.62/020,262 entitled “Dynamic 3D Lung Map View for Tool Navigation Insidethe Lung,” filed on Jul. 2, 2014, by Weingarten et al., the entirecontents of all of which are hereby incorporated by reference.

Although embodiments have been described in detail with reference to theaccompanying drawings for the purpose of illustration and description,it is to be understood that the inventive processes and apparatus arenot to be construed as limited thereby. It will be apparent to those ofordinary skill in the art that various modifications to the foregoingembodiments may be made without departing from the scope of thedisclosure.

What is claimed is:
 1. A method for assisting a clinician navigating toa target through a patient's bronchial tree, the method comprising:receiving location information and pose information from a probeinsertable into a working channel defined by a bronchoscope, thebronchoscope configured for insertion into the patient's bronchial tree,the probe configured to navigate through the patient's bronchial treeand including a sensor configured to generate the location informationand the pose information; executing a maximum intensity projection (MIP)algorithm for a range from a distal tip of the sensor according to thelocation information and the pose information; and presenting a userinterface that guides a user through a navigation plan, the userinterface configured to present: a three-dimensional (3D) view fordisplaying a 3D rendering of the patient's airways and a display of thenavigation plan; a local view for assisting the user in navigating theprobe through peripheral airways of the patient's bronchial tree to thetarget; and an alignment view for assisting the user in aligning adistal tip of the probe with the target, the alignment view including animage generated from the execution of the MIP algorithm.
 2. The methodaccording to claim 1, further comprising predetermining the range fromthe distal tip of the sensor.
 3. The method according to claim 1,further comprising dynamically calculating the range from the distal tipof the sensor based on a location of the target.
 4. The method accordingto claim 1, wherein the MIP algorithm highlights the target and filtersout densities of other tissue near the target.
 5. The method accordingto claim 1, further comprising presenting by the alignment view amarking overlaid on the target.
 6. The method according to claim 1,further comprising presenting by the alignment view a crosshair toassist alignment to a center of the target.
 7. The method according toclaim 1, further comprising presenting by the alignment view a distancefrom a tip of the sensor to the target.
 8. A method for assisting aclinician navigating to a target through a patient's bronchial tree, themethod comprising: executing a maximum intensity projection (MIP)algorithm for a range from a distal tip of a sensor according tolocation information and pose information received from a probeinsertable into the patient's bronchial tree; and presenting a userinterface that guides a user through a navigation plan of a 3D renderingof the patient's airways, the user interface configured to present analignment view for assisting the user in aligning a distal tip of theprobe with the target, the alignment view including an image generatedfrom the execution of the MIP algorithm.
 9. The method according toclaim 8, further comprising predetermining the range from the distal tipof the sensor.
 10. The method according to claim 8, further comprisingpresenting, via the user interface, a local view for assisting the userin navigating the probe through peripheral airways of the patient'sbronchial tree to the target.
 11. The method according to claim 8,further comprising dynamically calculating the range from the distal tipof the sensor based on a location of the target.
 12. The methodaccording to claim 8, wherein the MIP algorithm highlights the targetand filters out densities of other tissue near the target.
 13. Themethod according to claim 8, further comprising presenting by thealignment view a marking overlaid on the target.
 14. A method forassisting a clinician navigating to a target through a patient'sbronchial tree, the method comprising: receiving location informationand pose information from a probe insertable into a working channeldefined by a bronchoscope, the bronchoscope configured for insertioninto the patient's bronchial tree, the probe being configured tonavigate through the patient's bronchial tree, the probe including asensor, the sensor configured to generate the location information andthe pose information; executing a maximum intensity projection (MIP)algorithm for a range from a distal tip of the sensor according to thelocation information and the pose information; and presenting a userinterface that guides a user through a navigation plan, the userinterface configured to present an alignment view for assisting the userin aligning a distal tip of the probe with the target.
 15. The methodaccording to claim 14, further comprising predetermining the range. 16.The method according to claim 14, further comprising dynamicallycalculating the range based on a location of the target.
 17. The methodaccording to claim 14, wherein the MIP algorithm highlights the targetand filters out densities of other tissue near the target.
 18. Themethod according to claim 14, further comprising presenting by thealignment view a marking overlaid on the target.
 19. The methodaccording to claim 14, further comprising presenting by the alignmentview a crosshair to assist alignment to a center of the target.
 20. Themethod according to claim 14, further comprising presenting by thealignment view a distance from a tip of the sensor to the target.